- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.48 / $2,663.12 / $3,625.00
| Facility | | $438.48 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.92 / $434.86 / $715.64
| Professional | | $282.92 | $434.86 | $715.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.50 / $2,575.00 / $6,296.53
| Facility | | $510.50 | $2,575.00 | $6,296.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.71 / $742.18 / $3,238.16
| Professional | | $344.71 | $742.18 | $3,238.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.65 / $468.58 / $836.51
| Facility | | $364.65 | $468.58 | $836.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.67 / $648.47 / $1,233.43
| Professional | | $388.67 | $648.47 | $1,233.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $465.43 / $6,679.00
| Facility | | $214.32 | $465.43 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.47 / $625.78 / $863.83
| Professional | | $515.47 | $625.78 | $863.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.41 / $838.11 / $1,292.63
| Professional | | $400.41 | $838.11 | $1,292.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.21 / $232.21 / $232.21
| Professional | | $232.21 | $232.21 | $232.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,628.00 / $9,039.00
| Facility | | $55.00 | $2,628.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.82 / $947.75 / $3,238.16
| Professional | | $485.82 | $947.75 | $3,238.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.53 / $774.93 / $1,393.01
| Professional | | $469.53 | $774.93 | $1,393.01 |